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GRAPEVINE, TEXAS — Representatives of the nation’s largest physician group practices are saying a permanent fix to Medicare’s oft-postponed caps on physician pay isn’t dead yet — even if it’s barely breathing at this point.

Lobbyists for the American Medical Group Association, whose 435 members include some of the nation’s largest physician practices, predicted Congress will spend the next year looking for ways to cover the more than $130 billion cost of repealing the Medicare sustainable growth-rate formula. The SGR, which sets limits on the growth in government spending on physicians, currently dictates a cumulative 24 percent cut in physician reimbursement.

In early April, President Barack Obama signed the latest legislative “patch” passed by Congress, which delays those cuts until March 31, 2015. It was the 17th SGR patch over the last 11 years.

But even if Congress forges a bipartisan consensus on how to pay for repealing the SGR, nothing will get done before the next election, said Garrett Eberhardt, AMGA manager for government relations, and Chet Speed, vice president for public policy. They spoke Friday at the kickoff session of the AMGA annual meeting here.

“Our thinking is nothing will happen on SGR relief until March 31 (2015) at the earliest,” Speed said, adding that another short-term legislative patch delaying cuts through June 2015 was also conceivable.

However, the outcome of the November elections could have a major impact on efforts to permanently replace the SGR. If the Republican Party takes control of the Senate, the SGR “becomes a vehicle for ACA (Affordable Care Act) change,” Speed said, which “politicizes the SGR more than it is now.”

The cost of the previous 16 patches totaled $153.7 billion. Finding money for a permanent “doc fix” always has been the stumbling block to permanent repeal.

Senate Finance Committee Chair Ron Wyden (D-Ore.) has floated a number of budget gimmicks to pay for the permanent patch. However, counting as revenue the elimination of future patches or counting the end of future payments for the conflicts in Afghanistan and Iraq does not have wide appeal on the Hill.

Eberhardt suggested Congress could look for offsets among the recommendations of the Committee for a Responsible Federal Budget, which was chaired by Erskine Bowles and former U.S. Sen. Alan Simpson. Its proposals included means testing for Medicare beneficiaries, ending payments for “never events” like wrong-site surgeries and curbing payments for end-of-life care, all of which bring their own set of controversies.

Eberhardt said Congress could also take a closer look at aligning Medicare and Medicaid prescription drug purchasing policies, a move vehemently opposed by the drug industry. Sen. Jay Rockefeller (D-W. Va.) introduced a bill last year that would have returned rebate pricing for dual eligible beneficiaries, which he said would generate $141.2 billion in savings over 10 years.

Speed said another offset may be doing away with varying Medicare facility fees, which allow hospitals to be paid more for physician services when they are delivered in a hospital outpatient department rather than a doctor’s office. Variable facility fees, supported by hospital groups, were “the No. 1 pay-for Congress looked at” for the SGR, Speed said.

Speed noted that the AMGA does not have a formal position on facility fees. Its membership, which includes some very large physician practices, is split about 50-50 on the issue.

AMGA leaders also expressed regret about provisions in the SGR-fix bill that would delay implementation of the new ICD-10 procedure and diagnostic codes until Oct. 1, 2015, a one-year delay. Many AMGA member groups spent a lot of money preparing for this year’s Oct. 1 adoption date set by the CMS.

“People who took those steps were angered by the extension,” said Karen Ferguson, AMGA senior director of public policy.

On the other hand, Speed noted that physician organizations like the American Medical Association had lobbied against ICD-10 adoption. He said the delay could be seen as “a gift to placate the doctor societies” for failure to repeal the SGR.

“The payers support ICD-10, the systems tend to support it, and the hospitals certainly do,” he said.

Modern Healthcare is a sister publication to Crain’s Detroit Business.